Cancer is the most feared disease worldwide, and it is even more so in India where treatment outcomes are uncertain because of delayed diagnosis, patchy availability of specialised treatment and long and expensive therapies that most people without health insurance cannot afford.
Cancer continues to be diagnosed in late stages, when treatment is more toxic and expensive.
Cancer treatment, including radiation and chemotherapy not needing hospitalisation, will be covered under Ayushman Bharat’s annual Rs 5 lakh cover being offered to 550 million people.
Along with population-based screening programme for cervical, breast and oral cancers being expanded to all districts, treatment outcomes will improve in places where the services are available and uninterrupted.
Information from the Ayushman Bharat database will add to the knowledge gleaned from 26 population-based and seven hospital-based cancer registries used by the Indian Council of Medical Research (ICMR) to map the disease across states.
Data collection is a challenge because a high percentage of deaths occur at home without medical treatment. The cause of death in many cases is established based on verbal autopsy, where data collectors ask the family to describe symptoms that preceded the death. But information flow has improved substantially since the first population-based cancer
registry was established in Mumbai in 1963 and the first rural one in Barshi in Maharashtra in 1987.
These registries were quickly expanded to track the heterogeneity in cancer incidence and outcomes across states and between the urban and rural populations.
Despite the expansion, data availability, access to health care and affordability have remained static since 1990 in rural India, but have improved substantially in urban areas, the Global Burden of Disease paper reported in The Lancet Oncology last week. “The uniformly high cancer deaths might reflect the poor access to early detection and curative services and lack of affordability,” said the report.
Cancer deaths have more than doubled in India over the past 26 years, going up from 382,000 in 1990 to 813,000 in 2016, and now account for 8.3% of total deaths. While the incidence of breast cancer went up substantially during the period, incidence for cancers of the stomach, lip and oral cavity, cervical, oesophagus (food pipe), and leukaemia have decreased.
Cancers of lip and oral cavity, breast, cervix, lung and stomach are the most common , with tobacco being the biggest risk factor, found the study.
Except cancer of the cervix, the incidence of most cancers is much lower in India than Brazil, Russia, China, and South Africa, which are in a similar epidemiological transition. It is substantially lower than in some developed countries with established prevention, screening, and early detection programmes.
The age-standardised incidence of the most common cancers, except breast cancer, has remained static over the past two and half decades, despite under-reporting being more likely two decades ago.
A low-hanging fruit to fight cancer is to strengthen infrastructure and human resources for the prevention and control of the most common cancers, which include those of the mouth and lip, oral cavity, breast, cervix, stomach, lung, pharynx, colon and rectum, leukaemia, oesophageal and brain and nervous system.
Since smokeless tobacco is the biggest risk for many cancers, lowering use through increasing taxes, restricting
sale to minors, banning advertising and enforcing graphic package warnings will help lower cases.
Early screening for the three common cancers includes physical examination for oral and breast cancers, and visual exam with acetic acid for cervical cancer.
Even using these basic visual techniques will lead to early referrals and help keep thousands healthy after cancer diagnosis, given that screening the population for breast cancer would be an expensive, logistical challenge and there is no consensus to make HPV vaccination against cervical cancer a part of the universal immunisation programme.